Assessment of the Clinical Utility of Circulating Tumor Cells at Different Time Points in Predicting Prognosis of Patients With Small Cell Lung Cancer: A Meta-Analysis.

OBJECTIVES: Numerous studies have elucidated that circulating tumor cells (CTCs) have significant prognostic value in various solid tumors. However, the prognostic value of CTCs in small cell lung cancer (SCLC) remains controversial. The current study was performed to investigate the prognostic significance of different time points of CTCs in SCLC. METHODS: PubMed, EMBASE, Web of Science, and Cochrane Library databases were retrieved for eligible studies. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to investigate the association between CTCs level and overall survival (OS) and progression-free survival (PFS) in SCLC. Furthermore, subgroup analyses, sensitivity analysis, Begg's and Egger's tests were also conducted. RESULTS: Sixteen cohort studies with 1103 participants were eligible for this meta-analysis. Our results revealed that higher pretreatment CTCs level was significantly correlated with worse OS in SCLC no matter CellSearch (HR, 2.95; 95%CI, 1.56-5.58; P = .001) or other methods (HR, 2.37; 95%CI, 1.13-4.99; P = .023) was used to detect CTCs. Higher pretreatment CTCs status detected by CellSearch was associated with shorter PFS (HR, 3.75; 95%CI, 2.52-5.57; P < .001), while there was no significant association when other methods were adopted to CTC detection (HR, 2.04; 95%CI, .73-5.68; P = .172). Likewise, we observed that higher post-therapy CTCs level detected by both CellSearch (HR, 2.99; 95%CI, 1.51-5.93; P = .002) and other methods (HR, 4.79; 95%CI, 2.03-11.32; P < .001) was significantly correlated with decreased OS in SCLC. However, higher post-therapy CTCs count detected by CellSearch was not correlated with worse PFS (HR, 1.80; 95%CI, .83-3.90; P = .135). Sensitivity analysis demonstrated that the pooled data were still stable after eliminating studies one by one. However, significant publication bias was observed between pretreatment CTCs level detected by CellSearch and OS of SCLC. CONCLUSION: Dynamic monitoring of CTCs level could be a non-invasive and effective tool to predict the disease progression and prognosis in patients with SCLC.

The prognostic value of pretreatment prognostic nutritional index in patients with small cell lung cancer and it's influencing factors: a meta-analysis of observational studies.

BACKGROUND: Numerous studies identified that pretreatment prognostic nutritional index (PNI) was significantly associated with the prognosis in various kinds of malignant tumors. However, the prognostic value of PNI in small cell lung cancer (SCLC) remains controversial. We performed the present meta-analysis to estimate the prognostic value of PNI in SCLC and to explore the relationship between PNI and clinical characteristics. METHODS: We systematically and comprehensively searched PubMed, EMBASE, and Web of Science for available studies until April 17, 2020. Pooled hazard ratios (HRs) and their 95% confidence intervals (CIs) were used to evaluate the correlation between PNI and overall survival (OS) and progression-free survival (PFS) in SCLC. Odds ratios (ORs) and 95% CIs were applied to evaluate the relationship between clinical features and PNI in SCLC. RESULTS: A total of nine studies with 4,164 SCLC patients were included in the meta-analysis. The pooled data elucidated that lower PNI status was an independent risk factor for worse OS in SCLC (HR =1.43; 95% CI: 1.24-1.64; P<0.001), while there was no significant correlation between PNI status and PFS (HR =1.44; 95% CI: 0.89-2.31; P=0.134). We also found that Eastern Cooperative Oncology Group (ECOG) performance status ≥2 (OR =2.72; 95% CI: 1.63-4.53; P<0.001) and extensive-stage (ES) disease (OR =1.93; 95% CI: 1.62-2.30; P<0.001) were risk factors for low PNI, while prophylactic cranial irradiation (PCI) (OR =0.53; 95% CI: 0.40-0.69; P<0.001) was a protective factor for low PNI. CONCLUSIONS: Our findings suggested that low PNI status was closely correlated with the decreased OS in SCLC. Surveillance on PNI, amelioration of nutritional and immune status, and timely initiation of PCI may improve the prognosis of SCLC.

ROS/p53/miR­335­5p/Sp1 axis modulates the migration and epithelial to mesenchymal transition of JEG­3 cells.

Differential expression of microRNA (miR)­335­5p, a key tumor suppressor, has been detected in pre­eclampsia (PE) placentas. However, the role of miR­335­5p in the pathogenesis of PE and the factor modulating its aberrant expression remain unknown. The present study used JEG­3 cells in vitro to investigate these mechanisms. The role of miR­335­5p in proliferation, apoptosis and migration of JEG­3 cells was investigated using MTT, Annexin V­FITC/PI, Transwell migration and wound healing assays, respectively. miR­335­5p expression levels were analyzed using reverse transcription­quantitative PCR. The expression levels of E­cadherin, N­cadherin, Snail, specificity protein 1 (Sp1) and p53 were assessed using western blot analysis. Cell viability analysis was performed using the Cell Counting Kit­8 assay. The intracellular reactive oxygen species (ROS) levels were detected using a 2,7­dichlorodihydrofluorescein diacetate assay. The present results suggested that miR­335­5p did not affect the proliferation or apoptotic rate of JEG­3 cells. Overexpression of miR­335­5p significantly inhibited the migration of JEG­3 cells, decreased the expression levels of Sp1, N­cadherin and Snail, and increased E­cadherin expression. Sp1 silencing produced similar results in JEG­3 cells. H2O2 significantly increased the intracellular ROS levels and miR­335­5p expression, whereas N­acetyl­cysteine pretreatment prior to H2O2 treatment reversed the increases in miR­335­5p expression. Knockdown of p53 significantly decreased the expression levels of miR­335­5p in JEG­3 cells and in H2O2­treated cells. The present results suggested that miR­335­5p expression levels in trophoblast cells could be increased by ROS in a p53­dependent manner, leading to the downregulation of Sp1 and subsequent inhibition of epithelial to mesenchymal transition and cell migration. The present results may provide novel evidence on the etiology of PE.

Characteristics and clinical role of bronchoscopy in diagnosis of childhood endobronchial tuberculosis.

BACKGROUND: Endobronchial tuberculosis (EBTB) is the most frequent complication of primary pulmonary tuberculosis (PTB) in children. The aim of the study was to analyze characteristics and clinical role of bronchoscopy in diagnosis of childhood EBTB. METHODS: A retrospective, descriptive study was undertaken in 157 children with EBTB undergone flexible bronchoscopy (FB) between January 2006 and June 2014. RESULTS: The median age of the enrolled patients was 3.4 years, with 73.2% of patients under five years old. The most common subtype was tumorous type (145/157, 92.4%). If only involved bronchus were considered, the common affected sites were right middle lobe bronchus (49/228, 21.5%), left upper lobe bronchus (41/228, 18.0%), right upper lobe bronchus (41/228, 18.0%), right main bronchus (35/228, 15.4%), respectively. Children younger than five years old were at higher risk to have multiple endobronchial lesions (P=0.044), with an odds ratio of 2.313 (95% confidence interval: 1.009-5.299). Before the bronchoscopy, only 16 (10.2%) patients were highly suspected of EBTB, while the others were diagnosed as PTB without EBTB (69.4%), or misdiagnosed as pneumonia or foreign body aspiration (20.4%) on admission. CONCLUSIONS: The patients under five years old are at high risk to progress to EBTB and have multiple endobronchial lesions. The most frequent subtype of EBTB in children is tumorous type. The lesions are seen in the right bronchial system more frequently. FB should be performed to detect the endobronchial lesions in suspected patients as soon as possible.

Rapid diagnosis of childhood pulmonary tuberculosis by Xpert MTB/RIF assay using bronchoalveolar lavage fluid.

In order to evaluate the diagnostic accuracy of the Xpert MTB/RIF assay on childhood pulmonary tuberculosis (PTB) using bronchoalveolar lavage fluid (BALF), we evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of Xpert MTB/RIF assay using BALF in comparison with acid-fast bacilli (AFB) microscopy and Mycobacterium tuberculosis (MTB) culture for diagnosing childhood PTB using Chinese "composite clinical reference standard" (CCRS) as reference standard. Two hundred fifty-five children with suspected PTB were enrolled at Beijing Children's Hospital from September 2010 to July 2013. Compared with Chinese CCRS, the sensitivity of AFB microscopy, MTB culture, and Xpert MTB/RIF assay was 8.4%, 28.9%, and 53.0%, respectively. The specificity of three assays was all 100%. Xpert MTB/RIF assay could detect 33.9% of cases with negative MTB culture, and 48.7% of cases with negative AFB microscopy. Younger age (<3 years), absence of BCG scar, and contact with TB patient were found significantly associated with a positive result of Xpert MTB/RIF assay. In conclusion, Xpert MTB/RIF assay using BALF can assist in diagnosing childhood PTB much faster when fiberoptic bronchoscopy is necessary according to the chest radiograph.

Expression and clinicopathological significance of Mel-18 mRNA in colorectal cancer.

Mel-18 is a member of the polycomb group (PcG) of proteins, which are chromatin regulatory factors that play an important role in oncogenesis. This study was designed to investigate the clinical and prognostic significance of Mel-18 in colorectal cancer (CRC) patients. For this purpose, expression of Mel-18 mRNA was evaluated in 82 primary CRC and paired noncancerous mucosa samples by qRT-PCR and Western blotting. We found that overall Mel-18 mRNA expression in the CRC tissue was significantly lower than in the noncancerous mucosal tissue (p = 0.007, Wilcoxon matched-pairs signed-ranks test). Mel-18 was conversely correlated with the pathological classifications (p = 0.003 for T, p < 0.001 for N, and p = 0.015 for M classifications, respectively) and clinical AJCC stage (p < 0.001). Furthermore, CRC patients with a higher level of Mel-18 showed prolonged disease-free survivals (DFS) (p < 0.001). In multivariate analysis, the diminished Mel-18 expression may be a risk factor for the patients' 3-year DFS (HR = 1.895; 95 % CI 1.032, 3.477; p = 0.039). It was therefore concluded that the lower Mel-18 expression might contribute to the CRC development/progression.

Inactivation of Akt by arsenic trioxide induces cell death via mitochondrial-mediated apoptotic signaling in SGC-7901 human gastric cancer cells.

Arsenic trioxide (As2O3) has been recognized as a potential chemotherapeutic agent, yet the details concerning its mechanism of action in solid cancers remain undetermined. The present study assessed the role of Akt in the cell death induced by As2O3. The MTT assay showed that As2O3 suppressed the proliferation of SGC-7901 cells in a dose- and time-dependent manner. Characteristic apoptotic changes were observed in the As2O3­treated cells by Hoechst 33342 staining, and FACS analysis showed that As2O3 caused dose-dependent apoptotic cell death. As2O3 activated caspase-3 and -9, and PARP cleavage in a dose-dependent manner. Compromised mitochondrial membrane potential and an increased protein level of Bax indicated involvement of mitochondia. As2O3 decreased the levels of p-Akt (Ser473), p-Akt (Thr308) and p-GSK-3ß (Ser9), suggesting that As2O3 inactivated Akt kinase. In addition, LY294002 (a PI3 kinase inhibitor) augmented the apoptosis induced by As2O3. These results demonstrated that inhibition of PI3K/Akt signaling was involved in As2O3-induced apoptosis of gastric cancer SGC-7901 cells.

[Clinical analysis of bronchial foreign bodies in 246 children].

OBJECTIVE: To analyze the characters of bronchial foreign bodies in children and the utilization of bronchoscope in the treatment of bronchial foreign bodies. METHODS: A total of 246 children were diagnosed with bronchial foreign bodies at our hospital during January 2000 until August 2009. Under local mucosal anesthesia, a bronchoscope was inserted through nasal cavity into bronchi. After identifying the site of foreign body, grasping forceps was guided through bronchoscope to remove the foreign body from airway. RESULTS: Among 246 cases, hard nut and skin of melon seed were found (n = 230, 93.5%). The most common site of foreign body was in right lower lobe bronchi (n = 98, 38.9%). The average operative frequency was 1.9 +/- 1.3 and one-time extraction ratio 58.5% (n = 144). The one-time extraction ratio of patients with foreign body obstructed in main bronchi (91.1%), right middle lobe (60.0%) and right lower lobe (55.1%) was higher than others. The operation frequency of using basket grasping forceps (1.4 +/- 0.9) was lower than those using tooth type forceps (2.1 +/- 1.4). And the difference was significant (P = 0.000). CONCLUSION: For bronchial foreign body in pediatric patients, hard nut and skin of melon seed are the most common foreign bodies. The right and left lower lobe bronchi are the predilection site. Foreign body in main bronchus is the easiest to be removed by grasping forceps. For massive foreign bodies, basket grasping forceps fares better than tooth grasping forceps.

Five serum proteins identified using SELDI-TOF-MS as potential biomarkers of gastric cancer.

OBJECTIVE: The aims of this study were to detect serum proteomic patterns in gastric cancer serum samples using Surface-enhanced Laser Desorption/ionization-Time-of-flight-Mass Spectrometry ProteinChip array technology, to screen biomarker candidates, to build diagnostic models and to evaluate their clinical significance. METHODS: Serum samples from patients with gastric cancer and normal healthy control subjects (n = 125) were analysed using surface-enhanced laser desorption/ionization technology. The spectra were generated on weak cation exchange (WCX2) chips, and protein peak clustering and classification analyses were established using Ciphergen Biomarker Wizard and Biomarker Pattern software, respectively. The diagnostic models were developed and validated by discriminant analysis. In addition, the results of the surface-enhanced laser desorption/ionization model were compared with the biomarkers carcinoembryonic antigen and carbohydrate antigen 199 in a subset of samples using a microparticle enzyme immunoassay. RESULTS: Five protein peaks at 2046, 3179, 1817, 1725 and 1929 m/z were automatically chosen as components of the best biomarker pattern for diagnosis of gastric cancer. In addition, we identified a single protein peak at 4665 m/z, which could distinguish between stage I/II and stage III/IV gastric cancer with a specificity and sensitivity of 91.6% (11/12) and 95.4% (21/22), respectively. When this biomarker was validated in the second set of samples, the specificity and sensitivity were 91.7% (11/12) and 86.3% (19/22), respectively. CONCLUSIONS: The present results suggest that serum surface-enhanced laser desorption/ionization protein profiling can distinguish patients with gastric cancer, and in particular stage I/II patients, from normal subjects with a relatively high sensitivity and specificity. Surface-enhanced Laser Desorption/ionization-Time-of-flight-Mass Spectrometry is a potential new diagnostic tool for the screening of gastric cancer.

CHFR promoter hypermethylation and reduced CHFR mRNA expression in ovarian cancer.

BACKGROUND: Ovarian cancer is one of the most common cancers and can be treated with microtubule-targeting drugs. Checkpoint with forkhead and ring finger domains (CHFR) is a protein implicated in cancer sensitivity to microtubule-targeting drugs. Whereas CHFR downregulation, often with CHFR promoter hypermethylation, has been identified in a large number of tumor types, it has not been in ovarian cancer. We therefore searched for CHFR downregulation in primary ovarian tumors. METHODS: Fresh ovarian cancer tissues from 53 patients (test) and normal ovarian tissues from 21 patients (control) were tested for CHFR promoter hypermethylation and CHFR mRNA levels. RESULTS: The CHFR promoter was hypermethylated in 20.75% (11/53) of the ovarian cancers and none (0/21) of the normal controls. The normal controls had a mean mRNA level of 1.89 relative fluorescence units (RFU) with a range of 0.04-24.78 RFU. The cancer tissues had a mean mRNA level of 0.77 RFU with a range of 0.00-68.75 RFU. The median value of the cancer group was significantly lower than that of the control group (p=0.0067). Those cancer samples that had hypermethylated CHFR promoters also had low (n=3) or undetectable (n=8) CHFR mRNA levels. CONCLUSIONS: In contrast to previous reports, we found that alterations in CHFR mRNA and CHFR methylation can be frequently found in ovarian cancers. CHFR hypermethylation was strongly associated with the loss of CHFR mRNA expression. CHFR downregulation in ovarian tumors may be clinically relevant as a staging biomarker, as an indicator of sensitivity to microtubule-targeting drugs, and as a future drug target.

[The interaction between microsomal epoxide hydrolase polymorphisms and indoor pollution in non small cell lung cancer].

OBJECTIVE: To determine the interaction between indoor air pollution and mEH gene polymorphisms. METHODS: Blood samples from 222 non small cell lung cancer patients and 222 healthy people were characterized by PCR and PCR-RFLP methods. The interaction coefficients were determined through unconditional logistic regression model. RESULTS: Significant differences in the positive rate of mEH-exon3 mutant and the heterozygote were found between case and control groups (chi(2) = 7.046, P = 0.030). But no significant difference was found in mEH-exon4 non-wild-type between groups (chi(2) = 2.674, P = 0.263). mEH-exon3 mutant (OR = 1.99; 95% CI = 1.21, 3.25) could significantly increase the risk of lung cancer. After adjusted by confounding variables, significant interactions were found between the use of coal-wall stove and the non-wild type mEH gene. The interaction coefficients were increased with the duration of exposure and quantity of coal consumed. The super multiplication models were established between non-wild type mEH gene and the exposure to soot or oil fume during cooking. The interaction coefficients were 2.75 and 7.34 respectively for exon3 and exon4. No interaction was found between non-wild type mEH gene and irritation of eye or throat during cooking. CONCLUSION: Through the molecular epidemiological techniques, we confirmed indoor air pollution that caused by coal burning was a noticeable lung cancer risk factor. The interaction between the polymorphisms of mEH gene and the indoor air pollution plays an important role in the carcinogenesis of lung.

[Study on cytokeratin and CA125 for diagnosing lymph node micrometastases in endometrial cancer].

OBJECTIVE: To study the roles of cytokeratin (CK) and CA(125) in diagnosing lymph node micrometastasis in endometrial cancer. METHODS: The expressions of CK and CA(125) in 50 primary tumors and 298 lymph nodes from 50 patients with endometrial cancers were analysed by immunohistochemical methods. RESULTS: (1) The positive expression rates of CK and CA(125) in primary tumors of cases with endometrial cancer were respectively 100%, and 78%. (2) The expressions of CK and CA(125) in metastatic lymph nodes were both strong with 100% positive rate. In lymph nodes without metastasis, the expressions of CK and CA(125) were both weak, with positive rates of 15% and 12% respectively. (3) Among patients with stage I, II diseases, tumor recurrence rate was significantly higher in patients with positive CK or CA(125) expression in lymph nodes than in patients without CK or CA(125) expression (P < 0.05). (4) Multiple regression analysis revealed that in stages I, II endometrial cancer, CK expression in lymph nodes, and CA(125) expression in lymph nodes together with depth of myometrial invasion were relevant factors with tumor recurrence. CONCLUSIONS: CK expression in lymph nodes without metastasis can predict lymph node micrometastasis and is an independent risk factor for recurrence of disease in stages I, II endometrial cancers. CA(125) expression in lymph nodes without metastasis can also suggest lymph node micrometastasis, but it is not an independent predictive factor for tumor recurrence in stages I, II endometrial cancers.

[Impact of arsenic trioxide on proliferation and metastasis of drug-resistant human ovarian carcinoma cell line].

BACKGROUND & OBJECTIVE: The drug-resistance and metastasis in early stages of human malignant ovarian neoplasm have significant effect on chemotherapy of human ovarian carcinoma. The objective of this study was to explore the impact of arsenic trioxide(As2O3) on proliferation and metastasis of drug-resistant human epithelial ovarian carcinoma cell line 3AO/cDDP, in order to treat human ovarian carcinoma thoroughly. METHODS: The growing inhibiting rates of drug-resistant human ovarian carcinoma cell line 3AO/cDDP by various concentrations of As2O3 in different time course were studied by methyl thiazolyl tetrazolium (MTT) method; Apoptosis percentage, cell cycle phase distribution and expressions of Fas, N-myc, nm23H1 and MTA1 gene were estimated by flow cytometry (FCM); 3AO/cDDP cells apoptosis phenotype was observed by transmissional electron microscopy. RESULTS: 3AO/cDDP cell growing inhibiting rates by As2O3 were significantly different in dose-dependent and time-dependent manners(P < 0.05); Within a certain concentration range, 3AO/cDDP apoptosis inducing rates by As2O3 were dose- and time-dependent, and the most appropriate concentration was 3.0 mumol/L. Lower concentrations of As2O3 perturbed cell progressing through S/G2 phase, while higher concentrations selectively induced S phase cells apoptosis; As2O3 up-regulated Fas and nm23H1 gene expressions, but down-regulated N-myc and MTA1 gene expressions. Morphological observation indicated that As2O3 inducing 3AO/cDDP death characterized by apoptotic phenotype. CONCLUSION: As2O3 could influence the capacity of growth and proliferation of drug-resistant human ovarian carcinoma cell line and its mechanism could be positively and negatively related with Fas, nm23H1 gene and N-Myc, MTA1 gene expressions.